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December 27, 2006

Refusal of Care by Patients

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;296(24):2921-2923. doi:10.1001/jama.296.24.2921-b

To the Editor: In his Grand Rounds discussion, Dr Carrese1 described the difficult ethical problem posed by a patient's insistence on returning home from the hospital to an unsafe situation. Pursuit of legal options, though not applicable for Mrs A, was discussed as one possible response.

In England and Wales, legislation permits compulsory removal to suitable premises for persons who (1) “are suffering from grave chronic disease, or being aged, infirm or physically incapacitated, are living in insanitary conditions” and (2) “are unable to devote to themselves, and are not receiving proper care and attention.” A medical officer appointed by local government may apply to the court to remove such persons from their residence if it is considered in “their interests” or “for preventing injury of or serious nuisance to other persons.”2 The legislation is Section 47 of the National Assistance Act of 19482 and the Amendment Act of 19513 (introduced to deal with cases needing immediate action), collectively referred to as “Section 47.” Detention is allowed for up to 3 months by the 1948 act and for up to 3 weeks by the amendment act of 1951.

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